Form21 - [FORM 21-Use the top of this page for your...

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[ FORM 21 —Use the top of this page for your letterhead.] Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Privacy is a very important concern for all those who come to this office. It is also complicated, because of the many federal and state laws and our professional ethics. Because the rules are so complicated, some parts of this notice are very detailed, and you probably will have to read them several times to understand them. If you have any questions, our privacy officer will be happy to help you understand our procedures and your rights. His or her name and address are at the end of this notice. Contents of this notice A. Introduction: To our clients B. What we mean by your medical information C. Privacy and the laws about privacy D. How your protected health information can be used and shared 1. Uses and disclosures with your consent a. The basic uses and disclosures: For treatment, payment, and health care operations b. Other uses and disclosures in health care 2. Uses and disclosures that require your authorization 3. Uses and disclosures that don’t require your consent or authorization a. When required by law b. For law enforcement purposes c. For public health activities d. Relating to decedents e. For specific government functions f. To prevent a serious threat to health or safety 4. Uses and disclosures where you have an opportunity to object 5. An accounting of disclosures we have made E. Your rights concerning your health information F. If you have questions or problems A. Introduction: To our clients This notice will tell you how we handle your medical information. It tells how we use this information here in this office, how we share it with other professionals and organizations, and how you can see it. We want you to know all of this so that you can make the best decisions for yourself and your family. If you have any questions or want to know more about anything in this notice, please ask our privacy officer for more explanations or more details. B. What we mean by your medical information Each time you visit us or any doctor’s office, hospital, clinic, or other health care provider, information is collected about you and your physical and mental health. It may be information about your past, present, or future health or conditions, or the tests and treatment you got from us or from others, or about payment for health care. The information we col- lect from you is called “PHI,” which stands for “protected health information.” This information goes into your medical or health care records in our office. FORM 21. Notice of privacy practices (unabridged) (p. 1 of 5).
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This note was uploaded on 07/01/2010 for the course COUN 6682 A and taught by Professor All during the Spring '10 term at Walden University.

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Form21 - [FORM 21-Use the top of this page for your...

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